Is family planning solely women’s responsibility?

Karima Begum found herself in a challenging situation when her husband returned home.

They were separated for nearly a year this time, and the only issue that led to their repeated separations was his reluctance towards contraception.

Karima, who supports her four children by working as domestic help, takes contraceptive injections every three months to avoid unplanned pregnancies.

However, the process leaves the 46-year-old with a range of side effects.

"My menstruation cycle changes, leading to skipped periods a month while resulting in heavy bleeding the next," she said.

Working from morning till evening, Karima has to work at seven households for a monthly income of Tk 12,000.

A 2020 Nijera Kori study by Prof Zobaida Nasreen of Dhaka University's anthropology department revealed that 96 percent of male respondents believed birth control was solely a woman's responsibility.

"I feel sick which disrupts my work. Alongside enduring the day-long toil, unprecedented bleeding further worsens my situation. On top of it, I am gaining weight due to the injections and this hampers my stamina and mobility," she added.

Sidelining Karima's repeated efforts, her husband refused to use permanent contraceptive methods, citing concerns about a potential decrease in his workability, despite being a seasonal worker who doesn't contribute to his family.

"He returned this time upon the condition that I would take injections, despite the side effects," she said.

Sabrina Trina, a 24-year-old service holder married for 11 months, shared a similar experiences.

Due to her husband's unwillingness to use contraception, Trina has to rely on short-term contraceptive pills, as her husband feels family planning is her "sole responsibility".

Trina gets severe mood swings which affects both her professional and personal life. Her husband even forces her to take emergency contraceptive pills when she forgets to take her regular ones. This makes her worried about her fertility.

"Women are responsible for everything, be it infertility or family planning," she lamented.

LOW PREVALENCE RATE IN MEN

According to the Bangladesh Demographic and Health Survey 2022, the contraceptive prevalence rate in the country is 64 percent, with only 8 percent attributed to males.

The Directorate General of Family Planning (DGFP) lists seven contraceptive methods for couples, with only condoms and no-scalpel vasectomy (NSV) designated for men.

While the methods for males entail no side effects or incisional pain, the female counterpart comes with various drawbacks, including lower abdominal pain, spotting, mood swings, and weight gain, as per DGFP website.

A 2020 Nijera Kori study by Prof Zobaida Nasreen of Dhaka University's anthropology department revealed that 96 percent of male respondents believed birth control was solely a woman's responsibility.

Condom use among males was reported at 1 percent, with 86 percent admitting to never using them.

WHY THE RELUCTANCE?

The reluctance to use contraceptives is pervasive across all social classes, as highlighted by interviews with men from various backgrounds.

Aminul Islam, a 36-year-old street vendor in Mirpur, has not used any contraception since he got married in 2012, and is unsure what method his wife currently uses.

When asked why he doesn't use any method, he said, "That's women's stuff. I've seen her taking pills, and sometimes she gets injections too," he said.

Shafiqul Islam, a 34-year-old shopkeeper in Farmgate, married for the past 10 years, said family planning decisions in his household were primarily managed by his wife.

"I do not use condoms because it interferes with our quality time," he said.

And when it comes to long-term methods, he said, "I have heard that it makes guys weak and causes weight loss."

When asked if they had ever tried it, he replied in the negative.

Fahim Hossain, a 35-year-old businessman, disclosed that he and his friends viewed long-term contraceptive use as a threat to their masculinity, contributing to their avoidance of such methods.

"Many men joke about getting a vasectomy, saying it turns them into hijra who are unable to make a woman pregnant," he said.

Monjun Nahar, head of advocacy at Marie Stopes, suggested encouraging the use of non-hormonal methods, such as condoms, to promote shared responsibility.

"It is a safer option and also protects one from sexually transmitted diseases," she said.

Men's participation can be ensured by offering psychological support to women and being responsible partners, something lacking in many men, she mentioned.

"In many cases, they simply don't care, and instead of providing support or assistance, they resort to domestic violence. Many even discourage their partners when they want to opt for permanent methods," she added.

Abdul Latif Mollah, Director of Information Education Motivation Unit of DGFP, highlighted ongoing efforts to inspire and educate through various channels, including TV programmes, radio advertisements, and a dedicated call centre "Sukhi Poribar".

He noted the need for introducing new and innovative methods to increase male participation in family planning.

(Interviewee identities have been protected with pseudonyms)